Cost-effectiveness of nurse-led disease management for heart failure in an ethnically diverse urban community.
BACKGROUND
Randomized, controlled trials have shown that nurse-led disease management for patients with heart failure can reduce hospitalizations. Less is known about the cost-effectiveness of these interventions.


OBJECTIVE
To estimate the cost-effectiveness of a nurse-led disease management intervention over 12 months, implemented in a randomized, controlled effectiveness trial.


METHODS
Cost-effectiveness analysis conducted alongside a randomized trial.


METHODS
Medical costs from administrative records, and self-reported quality of life and nonmedical costs from patient surveys.


METHODS
Patients with systolic dysfunction recruited from ambulatory clinics in Harlem, New York.


METHODS
12 months.


CONCLUSIONS
Societal and payer.


METHODS
12-month program that involved 1 face-to-face encounter with a nurse and regular telephone follow-up.


METHODS
Quality of life as measured by the Health Utilities Index Mark 3 and EuroQol-5D and cost-effectiveness as measured by the incremental cost-effectiveness ratio (ICER).


RESULTS
Costs and quality of life were higher in the nurse-managed group than the usual care group. The ICERs over 12 months were $17,543 per EuroQol-5D-based quality-adjusted life-year (QALY) and $15,169 per Health Utilities Index Mark 3-based QALY (in 2001 U.S. dollars).


RESULTS
From a payer perspective, the ICER ranged from $3673 to $4495 per QALY. Applying national prices in place of New York City prices yielded a societal ICER of $13,460 to $15,556 per QALY. Cost-effectiveness acceptability curves suggest that the intervention was most likely cost-effective for patients with less severe (New York Heart Association classes I to II) heart failure.


CONCLUSIONS
The trial was conducted in an ethnically diverse, inner-city neighborhood; thus, results may not be generalizable to other communities.


CONCLUSIONS
Over 12 months, the nurse-led disease management program was a reasonably cost-effective way to reduce the burden of heart failure in this community.
Hebert
Paul L
PL
Health Services Research and Development, Veterans Affairs Puget Sound Health CareSystem, 1100 Olive Way, Suite 1400, Seattle, WA 98101, USA.
Sisk
Jane E
JE
Wang
Jason J
JJ
Tuzzio
Leah
L
Casabianca
Jodi M
JM
Chassin
Mark R
MR
Horowitz
Carol
C
McLaughlin
Mary Ann
MA
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000191:economics* / Q000208:ethnology / Q000451:nursing*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City; D024802:Nurse's Role; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D014505:Urban Population